Application for employment

Election Staff

Please return this form to:- Electoral Services, Town Hall, Walter Stranz Square,

Redditch B98 8AH | Call: 01527 881421 | Email:

Please submit evidence of your right to work in the UK for most people this is a copy of their passport. If you have any questions please call us on 01527 881421

1. Application for employment as:(Job Descriptions are available at &

All day work at polling station
6.30am to 10pm /
Evening work at counting station
9.30pm to 3am approx. /
Daytime work at counting station
day after polling day /
Postal Vote Assistant
on a day-to-day basis for two weeks prior to each election /
Door to Door Canvasser
Aug-Nov /

Please note: The timing and date of employment will vary based upon the type of election taking place. UK Parliamentary Election results are counted overnight immediately following the close of polls at 10pm. Local election results are usually counted the day after polling day.

2. About you

First Name Last Name

Address

Date of

Birth

National

Insurance

No.

Home Tel:

Work Tel:

Mobile:

Email:

Employer

(if any):

Transport available?Yes No

Your bank details

Name in

which

account is

held:

Sort Code:

Account

number:

Tax information – Please select one of the following statements

A /  / This will be my first job in the tax year beginning 6 April 2017 and I have not been receiving taxable Jobseeker’s Allowance, Employment Support Allowance or taxable Incapacity Benefit or a state or occupational pension
B /  / This is my only job in the tax year beginning 6 April 2017I do not have another job. I do receive taxable Jobseeker’s Allowance, Employment Support Allowance or taxable Incapacity Benefit. I do not receive a state or occupational pension
C /  / I have another job or receive a state or occupational pension

Student Loan Information

Student Loans (Advanced in the UK) Do you have a student loan which is not fully repaid and all of the following apply:-
  • You have left or will be leaving a course of UK higher education on or before 6 April 2016
  • And you received your first Student Loan instalment on or after 1 September 1998.

YES /  / NO / 

3. Previous Experience

Have you previously carried out this type of work? Yes No (If yes, please give details):-

Do you have any other relevant experience such as working in a customer facing role?

3. Assistance

If you have a disability, and think you may have difficulty with some of the duties outlined in the attached notes you will still be considered. If you have any special needs or require assistance please give details below.

4. Eligibility

Are you eligible to work in the UK?

(note: you may be required to provide your YesNo
passport or a document containing your NI Number)
Have you any criminal convictions in relation

to Electoral legislation?YesNo

5. Declaration

I confirm that the information supplied on this form is correct and that:

  • I am eligible to work in the UK and will supply proof of my right to work
  • I have no criminal convictions in relation to electoral legislation
  • I Confirm that if employed I will not be connected to, nor will assist any political party or candidate at the election. If I become aware of any possible conflict of interest I will notify the Elections Officer immediately
  • I am physically able to undertake the duties of the task(s) I am applying for
  • I understand that if employed I would be consenting to working in excess of the normal maximum working hours provided by the Working Time Directive
  • I agree to my details being stored on an Electoral Services computer database which will be subject to the provisions of the Data Protection Act 1998
  • This application is supported by my Line Manager/Supervisor (Bromsgrove District Council and Redditch Borough Council employees only)

Signed Date